One of the constant issues that volunteer agencies are faced with is the conflict between the moral mission of the agency versus the amoral policies and regulations that govern them. There are examples of this, although the most recent ones are not with specifically volunteer agencies.
The South Fulton Fire Department‘s refusal to extinguish the home of a non-subscribing resident is one such example. While Rogue Medic makes a very strong case in defense of the inactions of the South Fulton Fire Department, the outcry in the media and elsewhere on the internet indicates that the public feels otherwise. For that matter, I would like to give the benefit of the doubt to the firefighters and even their chief that their moral compass pointed them in the direction of extinguishing that fire but the amoral policy prevented it and therefore, at least in some opinions, justified their immoral behavior of doing nothing.
So what about when the foundation of your very agency is based upon a moral obligation to help another person?
The Amoral Policies
In New York State an ambulance service is issued a Certificate of Need for a territory (NYS Article 30 Section 10), or district, for which they are permitted to provide service for. This type of regulation can be viewed as a necessity for a few reasons. First, it holds commercial services to specific geographical locations that they are generally based from and does not allow them to go cherry picking in other areas served by other local commercial agencies. Second, it provides a boundary to which a municipal agency is responsible for to provide service. Finally, similar to the commercial services, it restricts the volunteers to serving their community first and foremost and helps prevent a cowboy mentality. These boundaries can however be crossed under a written mutual aid agreement and under some very specific circumstances as outlined in NYS DOH 800.21(o)
The boundaries of these territories for most volunteer agencies are most often along community borders which means that the boundaries are often divided. While the north side of the street may belong to one community, the south side may belong to another. This is a typical layout in not just urban areas but rural areas as well and as such provides the volunteer agencies with the proverbial landmine of inadvertently providing patient care out of their primary territory.
Now I know what you may be saying, what about “duty to act”? NYS DOH Policy Statement 98-05 addresses “duty to act” specifically and includes this line with my own added emphasis:
NYS statutes do not obligate an individual citizen, regardless of training, to respond to a situation or provide care unless there is a formal duty by job description or role expectation. Such a duty to act arises from participation with an agency having jurisdiction.
Therefore one can assume that if there is no obligation then there is no permission to provide care automatically outside of your territory.
The Moral Dilemna
As a volunteer agency founded with the mission of providing both non-emergency and emergency care and transportation the people we generally attract are those who are looking to provide philanthropic service locally. Admittedly, we also attract those who see the organization as a means to satisfy a self esteem deficiency with delusions of authority or heroism. These “buffs” or “whackers” or whatever name you call them locally are not necessarily bad people, but do tend to be primarily self serving under the guise of providing service. Nevertheless, the moral dilemma we face ourselves in is when either responding to a border job or while returning to the territory from a transport that took us outside of it and we come across a situation where the services of emergency care and transportation are required.
While our moral compass points us to perform our skills and intervene on the patient’s behalf to our fullest ability, the regulations and policies above indicate that we have no responsibiliy to do so and at the same time no permission to do so. This is compounded by the fact that although we are a volunteer organization, we do participate in a third-party revenue recovery program. While the loss of the revenue from calls outside the territory is not really a concern, compliance with billing regulations are.
Justifying Immoral Behaviour
The fear of the liability from violating these policies and regulations will eventually drive such an organization away from their moral foundations. The leadership will be forced to first regulate and then penalize those who while morally are fulfilling the mission of the organization are doing so in violation of the policies and regulations. This will result in either the collapse of the organization or justified immoral behavior from the personnel of an organization founded on moral principals.
In other words, ambulances will drive right by motor vehicle accidents outside their primary territory without stopping and they will be correct for doing so.
There’s just something about that which doesn’t seem right to me.
What’s your take on it? Let me know in the comments…